Stone composition and metabolic status |
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Authors: | B S Bibilash Adarsh Vijay Y M Fazil Marickar |
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Institution: | (1) Department of Surgery, Zensa Hospital, Trivandrum, 695009, India; |
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Abstract: | This paper aims to study the correlation between biochemical risk factors of the stone former and the type of oxalate stone
formed, namely calcium oxalate monohydrate (COM) and calcium oxalate dehydrate (COD). A retrospective study of 487 patients
who had been attending the urinary stone clinic, Trivandrum during 1998–2007 was conducted. The stones retrieved from them
were subjected to chemical analysis and FTIR spectrographic analysis. They were categorized into COM, COD, mixed COM+COD and
others. Of 142 pure calcium oxalate stone patients, 87 were predominantly COM stone formers and 55 COD stone formers. Their
metabolic status of 24 h urine and serum was assessed. The values of urine calcium, phosphorus, uric acid, magnesium, creatinine,
oxalate, citric acid, sodium and potassium, serum values of calcium, phosphorus, uric acid, magnesium and creatinine and calculated
values of creatinine clearance, tubular reabsorption of phosphate, calcium magnesium ratio and calcium oxalate ratio were
recorded. Comparison was made between the COM stone group and the COD stone group. Patients forming COM stones had significantly
higher mean values for urine calcium (P < 0.05), oxalate (P < 0.01) and magnesium (P < 0.05) levels and significantly lower level of urine calcium–oxalate ratio (P < 0.01) and urine calcium–magnesium ratio (P < 0.01) compared to COD stone forming patients. All other values failed to show significant difference. Patients, with higher
urine oxalate, formed COM stones. Those with low magnesium (which is an inhibitor) formed more of COD stones. Urine calcium
was high in both groups without showing significant variation from the mean. In patients with high calcium–oxalate and calcium–magnesium
ratios, there is higher chance of forming a COD stone than COM. Identification of the crystallization pattern of the calcium
stone will help in selecting treatment modalities. |
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